Individual
MRS. MINDI LYN MANCUELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2025 GLENN MITCHELL DR, VIRGINIA BEACH, VA 23456
(757) 507-1000
Mailing address
811 REDGATE AVE, NORFOLK, VA 23507-1515
(757) 668-7874
(757) 668-8658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA9104369
FL
363AM0700X
Medical Physician Assistant
001618
CT
363AM0700X
Medical Physician Assistant
Primary
0110004770
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182517415A
—
GA
05
—
2929279-00
—
FL
Enumeration date
06/10/2006
Last updated
02/18/2019
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